From the Guidelines
Bevacizumab can generally be used in patients with elevated bilirubin, but caution is advised. Unlike many chemotherapy agents, bevacizumab (Avastin) is not primarily metabolized by the liver and does not undergo significant hepatic clearance, making it relatively safe for patients with hepatic impairment 1. No specific dose adjustments are typically required based on bilirubin levels alone. However, the underlying cause of the hyperbilirubinemia should be carefully evaluated, as severe liver dysfunction may indicate poor overall prognosis or contraindicate aggressive cancer treatment.
Some key points to consider when using bevacizumab in patients with hyperbilirubinemia include:
- Monitoring liver function regularly during treatment
- Watching for bevacizumab's potential side effects, including hypertension, proteinuria, bleeding, and impaired wound healing
- Individualizing the decision to use bevacizumab based on the risk-benefit assessment, considering the severity of liver dysfunction, cancer type, treatment goals, and patient's overall condition
- Considering the use of bevacizumab in combination with other therapies, such as atezolizumab, for the treatment of hepatocellular carcinoma (HCC) in patients with preserved liver function 1
It is also important to note that bevacizumab may not be appropriate for all patients with HCC, particularly those with certain comorbidities or prior autoimmune diseases 1. Additionally, the use of bevacizumab in patients with HCC and invasion of the main portal vein has not been studied, and its efficacy and safety in this population are unknown 1.
Overall, the use of bevacizumab in patients with elevated bilirubin should be carefully considered and individualized based on the patient's specific clinical circumstances and the potential benefits and risks of treatment.
From the Research
Bevacizumab Use in Patients with Hyperbilirubinemia
- There is no direct evidence in the provided studies to suggest that bevacizumab can or cannot be used in patients with hyperbilirubinemia 2, 3, 4, 5, 6.
- The studies primarily focus on the adverse effects of bevacizumab, such as hypertension, proteinuria, thromboembolism, impaired wound healing, bleeding, and perforation 2, 3, 4, 5.
- None of the studies mention hyperbilirubinemia as a specific consideration for the use of bevacizumab.
- Factors associated with increased risks of adverse cardiovascular effects with bevacizumab include higher total treatment dose, concomitant hypertension, diabetes, atrial fibrillation, and lack of use of statin therapy 5.
- Bevacizumab is generally considered a well-tolerated therapy that can be safely given in combination with multiple chemotherapy agents in the induction and maintenance phases of therapy 6.